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Showing 22 posts in Patient Protection and Affordable Care Act (“ACA”).

ALERT – ACA Section 1557 Now in Effect – Is your rural health clinic in compliance?

Posted In Affordable Care Act, Patient Protection and Affordable Care Act (“ACA”), Rural Health Clinic

On October 16th, Section 1557 of the Affordable Care Act (“ACA”) went into effect, requiring all recipients of money from federal health care programs to provide language assistance for individuals with Limited English Proficiency at no cost. This section applies to rural health clinics (“RHCs”) as well, which means they must now comply with notice and assistance regulations as well as grievances in the cases of larger entities.  More >

Primary Care Providers – Are you feeling the pinch?

Posted In Affordable Care Act, Medicaid, Patient Protection and Affordable Care Act (“ACA”), Primary Care Physicians ("PCPs")

It was nice while it lasted – due to a provision of the Patient Protection and Affordable Care Act (“ACA”), services furnished by certain primary care providers (“PCPs”) were subject to an enhanced payment rate for Calendar Years 2013 and 2014. These PCPs had to have (a) been Board certified in the specialty designation of family medicine, general internal medicine or pediatric medicine or have a subspecialty designation recognized by specific boards or associations, or (b) furnished more than 60% of claims in specific evaluation and management or vaccine administration services under certain codes to have been eligible for these enhanced payments.[1] The payments were raised to the level of the Medicare Part B fee schedule rate (unless the actual billed charge for the service was lower), and providers had until April 1, 2013 to self-attest to being eligible.[2] The increase applied to both fee-for-service and managed care Medicaid plans. More >

ALERT - Supreme Court Upholds Affordable Care Act Insurance Subsidies

Posted In Affordable Insurance Exchanges, Patient Protection and Affordable Care Act (“ACA”)

In a 6-3 decision on Thursday, June 25th, the United States Supreme Court upheld the legality of the government healthcare insurance subsidies provided under the Patient Protection and Affordable Care Act (“ACA”) in the case of King v. Burwell. At issue was language in the ACA that granted subsidies to taxpayers enrolled in an insurance plan through “an Exchange established by the State.” 26 U.S.C. §§36B(b)(2)(A). More >

What changes are in store with the new CMS Proposed Rule for Medicaid managed care?

Posted In Centers for Medicare & Medicaid Services (“CMS”), Medicaid, Patient Protection and Affordable Care Act (“ACA”)

On June 1, 2015 the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule, revising the provisions of the Medicaid managed care (“MMC”) program for the first time in over twelve years. [1] The effects of these new regulations, if adopted, will be far-reaching, because the vast majority of Medicaid beneficiaries, especially in Kentucky, receive services through managed care plans. Medicaid expansion under the Patient Protection and Affordable Care Act (“ACA”) has led to growth in the number of people eligible for Medicaid managed care. The 201-page proposed regulation attempts to modernize Medicaid managed care and Children’s Health Insurance Programs (“CHIP”) so that they align with rules for other payers, including Medicare Advantage (“MA”) and qualified health plans (“QHPs”). More >

Wellness Programs and the EEOC, Part One

Posted In Health Insurance Portability and Accountability Act of 1996 (HIPAA), Patient Protection and Affordable Care Act (“ACA”)

On May 29, 2013, the U.S. Department of Labor, the U.S. Department of the Treasury, and the U.S. Department for Health and Human Services finalized rules regarding wellness programs offered in conjunction with group health plans. These changes were made in light of the Affordable Care Act (“ACA”). Prior to the enactment of the ACA, HIPAA provisions generally prohibited group health plans and group health insurance issuers from discriminating against individual participants and beneficiaries in eligibility, benefits, or premiums based on a health factor. The exception to the general rule allows premium discounts, rebates, or modifications to otherwise applicable cost-sharing systems (including copayments, deductibles, or coinsurance) in return for adherence to certain programs promoting health or preventing disease. More >

Pharmacists: Aren’t you really providers already? – Part Two

Posted In HPSA, Patient Protection and Affordable Care Act (“ACA”), Pharmacists

The first part of this article discussed pharmacist provider status and argument both for and against it. Today’s post now turns to regulatory hurdles, developments towards provider status and the acknowledgment of changing roles in the pharmacist workforce. More >

Pharmacists: Aren’t you really providers already? - Part One

Posted In Accountable Care Organizations (“ACO”), Affordable Care Act, HPSA, Medicare, Patient Protection and Affordable Care Act (“ACA”)

While the passage of the Patient Protection and Affordable Care Act (“ACA”) ushered in a new era of access to health care, it only served to exacerbate a growing crisis in the provision of health care – lack of providers. As of April 2015, the Health Resources and Services Administration lists the population of the United States that lives within a health professional shortage area (“HPSA”) for primary care as 103,847,716, with 1,023,989 of those living in Kentucky.[1] This shortage calls for a reimagining of ways that non-physician providers can fill the care gap, and the debate surrounding the provider status of pharmacists with regard to federal health care programs is evidence of a changing mindset. More >

CMS Rule on Medicare Overpayments? Don’t Hold Your Breath

Posted In Centers for Medicare & Medicaid Services (“CMS”), False Claims Act, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a final ruling. Unfortunately, providers’ anticipation for a final ruling will have to continue. On February 16th, CMS announced that it would delay the final rule on reporting and returning overpayment…by another full year! More >

Kentucky’s Evolving Behavioral Health Providers

Posted In Affordable Care Act, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

Psychology TherapyOne of the most important effects of the Patient Protection and Affordable Care Act (“ACA”) is the profound change in the coverage of behavioral health services. Building on the Mental Health Parity and Addiction Equity Act of 2008, the ACA requires both Medicaid and Medicare to provide far more robust behavioral health benefits, especially in the area of substance abuse. This expansion of benefits is not without growing pains - health care providers are waking up to the new reality of a vastly expanded need for substance abuse and other mental health services as well as providers. As state Medicaid programs struggle to finance these new benefits, the need for behavioral health care providers and clinicians has become acute. This is especially true in Kentucky, where access to substance abuse care is crucial due to the epidemic of prescription drug and heroin addictions. Fortunately, however, the Cabinet for Health and Family Services has taken proactive steps to strengthen and expand behavioral health infrastructure to meet the ACA’s directives. More >

Charitable Hospitals and Community Health Needs Assessments

Posted In Affordable Care Act, Charitable Hospitals, Community health needs assessment (“CHNA”), Patient Protection and Affordable Care Act (“ACA”)

In the last days of 2014, the IRS released regulations that finalized the compliance requirements for charitable hospitals. These new 2014 IRS regulations relate to the Community Health Needs Assessment (CHNA or needs assessment) requirements for nonprofit hospitals or nonprofit organizations Senior female doctor using a tablet computer in her officeoperating a hospital contained in Section 501(r) of the tax code, which was created by the Patient Portability and Affordable Care Act (“ACA”). Section 501(r) requires that thorough CHNAs be conducted every three years in order to maintain their 501(c)(3) nonprofit status. These needs assessments must define the community served by the hospital, the needs of the community, and a strategy addressing the identified community needs. Since each facility that fails to meet CHNA requirements loses its nonprofit status and has to pay a $50,000 excise tax, nonprofit hospitals and networks need to pay special attention to the changes and incorporate these new requirements into their needs assessments. More >

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